By Dan Balz and Chris Cillizza
Washington Post Staff Writer
Tuesday, January 19, 2010; A01
Democrat Martha Coakley's struggle to stave off a potentially devastating defeat in Tuesday's special Senate election in Massachusetts marks a critical turning point in the year-long debate about health-care reform. Regardless of the outcome of the race, the two parties appeared headed toward a monumental clash over the issue in the coming midterm elections.
A victory by state Sen. Scott Brown, who was given little chance of winning only a few weeks ago, would give Republicans 41 votes in the Senate and further embolden them to challenge the core of President Obama's agenda. Democrats could face an internal battle over how or even whether to proceed with the legislation, as well as how to deal with the issue in the fall races.
House Speaker Nancy Pelosi (D-Calif.) sought to head off possible talk of retreat, vowing to press ahead with the legislation. "There is no 'back to the drawing board,' " she told reporters Monday in San Francisco. She said there will be a final health-care bill "one way or the other."
But Republicans were warning of a political backlash if Democrats proceed in the face of a Brown victory.
Obama did not directly mention health-care reform when he campaigned Sunday on behalf of Coakley, the state attorney general, who is running to fill the seat of the late Edward M. Kennedy. Even before the polls opened, White House officials sought to blunt the narrative that the race was a referendum on the president's health-care initiative, in part by arguing that Massachusetts already has universal coverage.
"Massachusetts is completely unique, because the health reform law passed a few years ago," White House communications director Dan Pfeiffer said. "It makes it an imperfect example and impossible to extrapolate."
Other Democrats argued that Coakley, rather than health-care reform or Obama, bears principal responsibility for allowing the race to become so close, noting that in many of their private polls in the state, both the president and his initiative are more popular than the attorney general.
Republicans scoffed at the assertion that health-care reform has not been a driving force, noting that Brown has campaigned hard on the message that he would be the 41st vote against the legislation in the Senate and that the anger and discontent about Obama's agenda has helped fuel the Republican's rise in the polls.
"Health care has transcended issue status," GOP strategist Mary Matalin said. "It now represents something quite irregular in American politics: The obsession of a liberal minority thwarting the will of an intense supermajority for the better part of a year now."More oppose reform
A new Washington Post-ABC News poll found that 44 percent of Americans support the proposed changes in the health-care system being debated in Congress, while 51 percent oppose them. Opposition is more intense than support, with 39 percent saying they strongly oppose the legislation and 22 percent saying they strongly favor it.
Fifty-three percent said the changes would mean higher personal costs, and 50 percent said the quality of their health care would be better if the measure did not pass. Fifty-six percent said the overall cost of the initiative nationally would be higher under the plan advanced by the president and the Democrats.
Congressional negotiators agreed last week to tax high-cost health plans, as the Senate bill proposes, rather than raising taxes on the wealthiest Americans. The public, however, favors raising taxes on the rich by 58 percent to 22 percent. Americans are closely divided over whether those covered by a government-sponsored insurance option should be allowed to buy coverage for abortions.
Despite the general opposition to the legislation in this and other polls, Democrats reiterated Monday their belief that, once the politically debilitating debate ends, they can turn health-care reform into a winning issue. Their strategy is to make a populist argument that they say will put Republicans on the defensive for opposing politically popular measures designed to check the power of insurance companies.
"The only way to win this debate is to get the bill passed and implement it," White House senior adviser David Axelrod said. He said that public fears about the legislation are "based on a caricature" that will disappear once people learn more about the benefits. "That's the case we're going to make," he said.Debate preview
As both sides looked to Tuesday's balloting in Massachusetts, strategists offered a preview of the coming debate.
Joel Benenson, Obama's lead pollster in the 2008 campaign, said every Republican lawmaker has voted against a bill that includes provisions that would stop a number of practices by insurance companies, including denying coverage because of preexisting conditions and imposing annual or lifetime limits on coverage.
"They had their chance and they just opposed it," he said. "They took the insurance industry line down the line. That's how you draw that contrast. That's a fight that . . . we'll be happy to make."
Democrats are "not dealing with reality," said Republican pollster Ed Goeas, saying that there was no way Democrats could "twist it and turn it" to justify the measure to a skeptical public. The party, he said, argues that it can expand coverage, keep the quality of care high and cut costs for average families. The public, he added, "will come to the conclusion that you can't."
Democrats note that the health-care debate is at an especially intense point, with lawmakers and White House officials engaged in lengthy negotiations to reconcile competing versions from the House and Senate. Democratic strategists say the key will be to pivot from defense to offense.
"If we are talking about whether someone wants to repeal the new money for filling the doughnut hole" on prescription drug benefits, "the ban on denials for preexisting conditions, the limitations on year or lifetime coverage and things like that -- it's a better debate," Democratic pollster Geoffrey Garin said.
"The Democrats' argument to date has been 'Okay, these are bad numbers, but it's the sausage making, and if they pass the bill they can reframe it and be better off,' " said Bill McInturff, a Republican pollster whose firm has done the surveys for Brown. Sounding bullish about Massachusetts, he added: "I am coming to a different conclusion today than I would have last week. This bill has now been rejected by the American public."
Democrats are determined to prove that assertion wrong, by either a Coakley victory in Massachusetts or a major public relations effort this year. But the outcome in Massachusetts now stands as the marker that lawmakers in both parties will use to assess the politics of the issue that has gripped the country for so long.
Polling director Jon Cohen contributed to this report.